The status of the receptor-controlled calcium metabolism of the thrombocytes in patients in the early postoperative period]

Basic changes in receptor-controlled platelet calcium metabolism that occur in the early postoperative period under the effect of aggregation-inducing hormones--platelet activation factor (PAF), adenosine phosphate (ADP) and vasopressin--are reviewed. Patients after lung surgery and patients with ischemic heart disease after aortocoronary bypass surgery have been examined. Patients operated on for malignant lung tumours developed increased postoperative sensitivity to ADP, while in patients after aortocoronary bypass surgery the early postoperative period was characterized by decreased sensitivity to PAF and vasopressin.     

General anesthesia, hormones and hemodynamics during the excision of tumors of the posterior cranial fossa]

The levels of tropic and peripheral hormones (ACTH, TSH, STH, T3, T4, hydrocortisone, insulin) have been assessed in 74 patients, aged 16 to 64 years, operated on for posterior cranial fossa tumors. Depending on the basic anesthesia component the patients were divided into 3 groups: patients on halothane anesthesia, patients on anesthesia with azeotropic mixture, patients on neuroleptanalgesia. Three hemodynamic variants in the course of operation and postoperative period have been established: patients with normal blood pressure, heart rate, stroke volume; patients with elevated and high blood pressure; patients with unstable hemodynamics. It has been found that general halothane and azeotropic mixture anesthesia is associated with marked changes in intraoperative endocrine function. Endocrine function is changed on the 3rd and 7th day postoperatively due to surgical brain trauma.     

Clinical use of tramal in patients in the early postoperative period

Tramal was given to 204 patients who were operated on the lung, heart, abdomen. During pain therapy, good and satisfactory results were on average obtained in 75% patients operated on the lung, in 77%, on the heart, in 89%, on the abdomen, in 70%, on the great vessels. The absence of the inhibitory effect of the drug on the respiratory center and its slightly marked sedative effect allow one to recommend the agent for application in the early period following the surgery when narcotic analgesics still retain their effect and a real risk of their overdosage exists. During prolonged artificial pulmonary ventilation in the early postoperative period and in impaired adaptation of the patients to a respirator, tramal aids normalization of lung mechanics and hemodynamic parameters without eliminating and suppressing the patients' consciousness and results in cessation of muscular shivering. Adverse effects of tramal are of no decisive clinical significance and occur mainly when the drug is rapidly injected into the vein.     

丙型肝炎病毒阳性受者肾移植后的安全性分析

背景：对于丙肝病毒阳性患者接受肾移植后安全性的问题是目前大家关注的热点。目的：丙型肝炎病毒感染者接受肾移植后临床观察及处理对策。方法：纳入22例患者,肾移植前肝炎病毒RNA均为阳性,其中14例患者肝功能轻度升高。移植后定期检测患者的肝、肾功能,积极防治可能的排斥反应。主要观察患者一般情况、肝、肾功能、肝炎病毒基因学情况及死亡率。结果与结论：移植后随访6~36个月,20例患者移植后4周~6个月内出现不同程度的肝功能异常,予护肝治疗后肝功能均恢复正常,1例移植后HCV-RNA阳性患者,因自行改变抗排斥方案于移植后1.5年出现严重的肝功能衰竭而死亡;4例患者移植后应用干扰素和利巴韦林治疗,HCV-RNA转阴,其余18例患者HCV-RNA均呈阳性,需长期护肝治疗。表明,对丙肝病毒阳性受者,移植后应进行严格的随访,出现肝功能异常时,及时采取相应处理和护肝治疗。     

原位肝移植围手术期成分输血相关问题的探讨

目的　探讨成人原位肝移植围手术期出凝血功能的变化及输血对手术预后的影响。方法　对肝移植术前肝功能Child分级均为C级 ,出凝血功能均存在异常的 19名患者通过补充凝血因子、血小板等成分进行纠正。无肝期采用体外静脉转流 ,术中动态监测血流动力学、出凝血功能变化及出血量 ,根据无肝前期、无肝期、新肝期各项出凝血功能指标的变化 ,给予相应的输血处理 ,分别以术后生存情况和围手术期输血量分组 ,分析各种输血因素对移植术中、术后的影响。结果　在术前肝功能分级、出凝血功能、手术方式、方法、时间无明显差异的情况下 ,输血总量、红细胞用量、冰冻血浆用量与术后存活率呈明显负相关 ,偏相关系数分别为 - 0 .75 18(P <0 .0 1)、- 0 .710 4 (P<0 .0 1)、- 0 .5 14 4 (P <0 .0 5 )。死亡组输血量明显高于存活组 ,差异显著 (P <0 .0 5 ) ;输血量≥ 10 0 0 0ml组死亡率明显高于输血量 <10 0 0 0ml组 ,差异显著 (P <0 .0 5 ) ;所有病例中无一发生输血后巨细胞病毒 (CMV)感染、颅内出血。结论　术前充分纠正出凝血功能异常 ,术中进行动态监测 ,及时通过各种血液成分在品种和剂量上的合理输注进行调控及应用去白细胞输血等新技术 ,可保证原位肝移植手术顺利进行 ,有效降低输血总量 ,减少术后并发症。     

Relationships of cyclosporine concentrations in serum, whole blood, and bile after renal and hepatic transplantation

"Trough" (minimum inter-dose) cyclosporine concentrations were measured by liquid chromatography in samples of serum and whole blood or bile obtained from renal- and hepatic-transplant patients. Overall, concentrations in whole blood correlated poorly with concentrations in concurrently obtained serum. The poor correlation also held for individual patients over time. The degree of variability observed for individuals is especially disconcerting. Although cyclosporine measurements in whole blood may mitigate time- and temperature-dependent changes in the drug's distribution after collection, concentrations in serum separated after distribution are less dependent on the cellular mass in blood, and may better reflect the amount of drug available to receptor sites. This consideration may be particularly important in the postoperative period, when fluctuations in the cellular mass of blood are frequent. Concentrations of cyclosporine were also determined in concurrently collected bile and serum samples after liver transplantation. Concentrations of unchanged drug in bile were variably higher than those in serum. Bile/serum concentration ratios ranged from 65/1 to 4.6/1. It is postulated that bile/blood concentration ratios may reflect liver function.     

Clinico-laboratory and morphological parallels in hepatic echinococcosis

The trial included 50 patients with hydatid echinococcosis of the liver and 5 control patients operated urgently for extrahepatic pathology. The patients underwent clinical and biochemical tests, ultrasound investigation of the liver. Structural and functional changes in the liver were analysed with reference to the stage of the echinococcal cyst. Morphological picture of the liver was studied by light microscopy, its functional picture--by activity of AsAT and AlAT in hepatic tissue. Morphological and biochemical tests were made on hepatic biopsies obtained from the pericystic and far from the cyst zones. The most severe histological changes affecting all structures of the liver were registered in the parasite's life cycles II and III. AsAT and AlAT changes in the liver were not related to the biological cycle of the parasite; echinococcal patients' liver contained them in lower concentrations than that of control subjects. Moreover, blood serum levels of AsAT and AlAT are higher than in liver tissue. Thus, growth of the echinococcal cyst in the liver is accompanied with marked morphofunctional disorders. This necessitates early detection and surgical treatment of hepatic echinococcosis. To prevent postoperative complications, adequate preoperative preparation and postoperative intensive treatment must be conducted.     

The heparin prophylaxis of gas exchange disorders in disseminated intravascular blood coagulation]

Altogether 35 patients operated on for gastric carcinoma were examined. In the postoperative period, a study was made of alterations in gas exchange function of the lungs parallel with the parameters of the hemostatic system. It has been established that in the early postoperative period, arterial hypoxemia was associated with the maximum tension of the functioning of the hemocoagulation system. Administration of heparin in a dose of 20,000 Units/day for 10 days led to a decrease of the period of arterial hypoxemia and reduction of its intensity. This is related to the blockade of intravascular blood coagulation. The heparin dose administered does not influence the plasma content of antithrombin-III and blood fibrinolytic activity.     

Changes in metabolism and blood flow in peripheral tissue (skeletal muscle) during cardiac surgery with cardiopulmonary bypass: the biochemical microdialysis study

The aim of this study was to monitor the metabolism and blood flow in the interstitium of the skeletal muscle during cardiac surgery with cardiopulmonary bypass (CPB) and in the early postoperative period by means of microdialysis and to compare metabolic changes during CPB at normothermia (NT) and hypothermia (HT). Surgical revascularization using CPB was performed in 50 patients, 25 patients (group HT) were operated using hypothermic CPB, 25 (group NT) using normothermic CPB. Interstitial microdialysis was performed by two CMA 60 probes (CMA Microdialysis AB, Solna, Sweden) inserted into the patient's deltoid muscle. Constituents analysed in the obtained dialysates, collected at intervals, were glucose, urea, glycerol and lactate. Tissue blood flow was monitored by dynamic microdialysis with gentamicin as a marker. In both groups, NT versus HT, similar dynamics of concentrations were found. Low initial concentrations were followed by gradual increases during CPB and in the following phase of the operation. Concentrations were higher in the NT group. Immediately after the operation, the decrease in values continued, with a gradual increase in the succeeding postoperative period in both groups. Similar dynamic changes in the lactate concentration were found in both groups. The gentamicin concentrations were lower in the NT group (versus the HT group). The results showed dynamic changes in the interstitial concentrations of glucose, urea, glycerol and lactate, which depend on the phase of the surgery in the CPB and early postoperative phase in the both groups of patients. Higher tissue perfusion of the skeletal muscle was noted in those patients operated on in normothermia. The dynamics of the concentration changes of these substances in the interstitium of the skeletal muscle has been proven to be caused by both the metabolic activity of the tissue and by the blood flow through the interstitium of the muscle.     

Pharmacokinetics of antipyrine in viral and alcoholic lesions of the liver

Parameters of antipyrine pharmacokinetics have been studied in 82 patients with viral, alcoholic and combined liver affections and in 19 healthy subjects. All the patients exhibited changes showing a reduction of liver function responsible for drug metabolism. Disturbances of antipyrine pharmacokinetics were more pronounced in acute alcohol-aggravated hepatitis B than in hepatitis B without alcoholic aggravation.     

Postoperative analgesia using moradol in emergency surgery

Moradol was used for postoperative analgesia in 39 patients subject to urgent surgery. Promedol was used as a control. It has been found that a marked pain syndrome in the early postoperative period in patients examined was characterized by certain deviations of the parameters studied. Moradol, as compared to promedol, has a better analgesic effect, causing milder respiration and hemodynamic changes. With intravenous drug injection, a more profound analgesia is associated with a greater respiratory depression.     

急性梗阻性化脓性胆管炎患者术后应用r-hGH的临床意义

目的通过对急性梗阻性化脓性胆管炎患者（AOSC）术后应用人重组生长激素（r-hGH）,探讨r-hGH在AOSC患者康复中肝脏功能及炎症变化的临床意义。方法将82例AOSC患者：随机分为实验组（术后立即应用r-hGH,46例）和对照组（术后按常规抗炎、护肝及利胆治疗,36例）。分别在术后第1、3、6天动态检测两组患者的血清IL-10、血浆内毒素（ET）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、总胆红素（TB）等。结果①两组AOSC患者入院时血清IL-10为356.9±31.6 Pg/ml、血浆内ET高达282.73±27.48 ng/L;②术后两组在各时段的IL-10、ET值具有差异改变P〈0.05。③术后两组患者血清ALT、AST、TL检测值在各时段对比均呈差异性改变P〈0.05。结论根据术后两组患者5组检测值的动态变化分析,①实验组机体免疫机能明显高于对照组,应用r-hGH具有激活患者机体的免疫机制,提高患者的抗病力的能力;②实验组AOSC患者术后肝细胞功能恢复速度明显优于对照组,实验数据显示r-hGH有促进AOSC患者术后肝功能的改善能力,加速AOSC患者的康复。     

Marked effect of liver and kidney function on the pharmacokinetics of selegiline

OBJECTIVES: The pharmacokinetics of selegiline was investigated in an open study with 4 parallel groups of 10 subjects in each. Patients with liver disease, those receiving a drug that induced hepatic enzyme activity, and those with impaired kidney function were compared with control subjects. METHODS: A single oral 20-mg dose of selegiline was administered after an overnight fast, and blood samples were collected over a period of 48 hours. Concentrations of serum selegiline and its main metabolites were determined and pharmacokinetic parameters calculated. RESULTS: The pharmacokinetic parameters of selegiline differed considerably between the patient groups and the control subjects. The area under the concentration-time curve of serum selegiline was, on average, 18-fold higher (P < .05) in patients with impaired liver function, 23-fold lower (P < .001) in patients with drug-induced liver function, and 6-fold higher (P < .05) in patients with impaired kidney function as compared with the control subjects. There was a large interindividual variation in every group. The changes in selegiline metabolite kinetics supported the changes in the kinetics of the parent compound. CONCLUSION: The elimination rate of selegiline was substantially increased in patients with drug-induced liver function and decreased in patients with impaired liver or kidney function when compared with control subjects. These results suggest that selegiline dosage adjustments may be required in patients with altered liver and kidney function.     

The significance of respiration disorders in the development of postoperative pulmonary complications in patients with cancer of the stomach

Complex postoperative examination of the respiratory system in patients with gastric cancer made it possible to compare the results of respiratory function and pulmonary mechanics testing with the course of the postoperative period. The effect of bronchopulmonary system function on the onset of postoperative respiratory complications has been established.     

原位心脏移植术后血流动力学监测及治疗

目的 探讨原位心脏移植术后血流动力学监护及治疗对提高心脏移植早期存活率的意义。方法 41例晚期心脏病患者接受同种异体原位心脏移植，术后密切监护移植心脏的功能，维持患者的血流动力学稳定。结果 所有患者术后均接受血管活性药物治疗，移植早期6例患者发生移植心脏急性右心衰竭而死亡，35例患者长期存活，生活质量良好。结论 原位心脏移植术后去神经心脏具有特殊的血流动力学特点，围术期密切躲护和注意血管活性药物的合理科学应用是减少早期移植物急性功能不全的关键。     

Frequency and reliability of alarms in the monitoring of cardiac postoperative patients

Postoperative monitoring of cardiac operated patients requires appropriately functioning monitor alarms as well as intensive nursing activity. The limit alarms can be used for detection of life-threatening situations and monitoring of physiological changes in the patient's state. We studied the significance and the frequency of audible alarms during the postoperative intensive care of ten cardiac patients. Of 1307 occasions when such an alarm was activated during the study period of approximately 26 hours per patient, only 139 (10.6%) were significant. The highest proportion of significant audible limit alarms was found during the immediate postoperative period. Heart rate alarms were more reliable than alarms of the other parameters monitored in the study. Possibilities for improving the physiological monitoring and alarm system are discussed.     

Frequency and reliability of alarms in the monitoring of cardiac postoperative patients

Postoperative monitoring of cardiac operated patients requires appropriately functioning monitor alarms as well as intensive nursing activity. The limit alarms can be used for detection of life-threatening situations and monitoring of physiological changes in the patient's state. We studied the significance and the frequency of audible alarms during the postoperative intensive care of ten cardiac patients. Of 1307 occasions when such an alarm was activated during the study period of approximately 26 hours per patient, only 139 (10.6%) were significant. The highest proportion of significant audible limit alarms was found during the immediate postoperative period. Heart rate alarms were more reliable than alarms of the other parameters monitored in the study. Possibilities for improving the physiological monitoring and alarm system are discussed.     

The binding capacity of albumin in patients with gastric cancer

The time course of changes in albumin values was studied in the early postoperative period in patients with gastric cancer who had been operated on, by using intraoperative radiation therapy (IORT). The fluorescence technique was used to determine the total and effective concentrations of albumin, the reserve of its binding, and the toxicity index in the blood serum of patients with stage III gastric cancer 2 hours before and 30 min, 1, 3, 5, 7, and 14 days after surgery. The results indicated that the minimal albumin concentration was observed on postoperative day 3. When the concentration of albumin is measured by other techniques, one should take into account a significant difference between the effective and total concentrations of albumin. The reserve of albumin binding postoperatively decreased, by showing its minimum values on study day 14. The toxicity index increased from postoperative day 3. The maximum toxicity index was seen on days 7 and 14.     

肝硬化患者红细胞天然免疫黏附功能围术期变化

目的：研究肝硬化患者围手术期红细胞天然免疫功能（RNIAF）的变化。方法：40例病人分为两组，30例为肝炎后肝硬化患者。10例无肝功能异常的患者作为对照组。分别于麻醉前、麻醉后、术后1d、术后3d及术后7d抽取静脉血，采用红细胞在自身血浆中天然免疫黏附肿瘤细胞的方法测定红细胞天然免疫黏附功能。结果：围手术期肝硬化患者红细胞天然免疫功能不同程度低于正常人群（P〈0．05）：随着肝硬化ChildA、ChildB、ChildC分级依次加重；肝硬化患者红细胞天然免疫功能麻醉前后差异无显著性（P〉0.05）；术后第3天RNIAF水平显著性下降（P〈0.05）。肝硬化患者红细胞天然免疫黏附功能与水平相关。结论：红细胞天然免疫黏附功能可以作为判断肝病围手术期病情发展变化的指标，对判断手术后病情发展、肝功能和预后具有重要作用。     

Liver blood flow during xenon anesthesia in surgical hepatology

The authors present their experience gained in anesthesias for resection of the liver. Methods for evaluating total liver blood flow by ueveredine dilution, portal blood flow by thermodilution, changes in arterial blood supply during and after the operation are discussed. Effects of methods of anesthesia on total liver blood flow and some parameters of systemic hemodynamics are analyzed. Effects of neuroleptanalgesia, ketamine and xenon anesthesia on liver blood flow are compared. The efficiencies of anesthesias for resection of the liver and their effects on liver function during and after the operation are evaluated. The results evidence that disorders in liver circulation parameters were far less pronounced in the patients operated on under Xe anesthesia in comparison with patients operated on under neuroleptanalgesia and calypsol anesthesia. The study confirmed a pronounced analgesic effect of xenon, and clinical results confirmed that Xe anesthesia can be used in traumatic interventions.